This Week in JAMA FREE

Erythropoietin has been associated with reduced infarct size in experimental models of myocardial infarction. To assess whether erythropoietin has a similar effect in the clinical setting, Najjar and colleagues Article randomly assigned patients with ST-segment elevation myocardial infarction (STEMI) to receive either a single intravenous bolus (60 000 U) of epoetin alfa or saline placebo within 4 hours of successful percutaneous coronary intervention. Infarct size was assessed 2 to 6 days after study medication administration. The authors report that epoietin alfa was not associated with reduced infarct size, and in subgroup analyses of patients aged 70 years or older, infarct size was larger among patients who received epoietin alfa. In an editorial, Bhatt Article discusses clinical evaluation of agents to reduce infarct size.

The ability to predict tumor response and survival following chemotherapy would improve clinical decision making for patients with cancer. In a prospective study of women with newly diagnosed invasive breast cancer, Hatzis and colleagues analyzed tumor gene expression microarrays to identify gene signatures associated with chemotherapy resistance and response. The authors found that estrogen receptor status and a combination of genomic signatures that reflect chemoresistance, chemosensitivity, and endocrine sensitivity predicted patients who would have a high probability of survival following taxane and anthracycline chemotherapy.

In the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) study, which compared optimal medical therapy alone with optimal medical therapy plus percutaneous coronary intervention (PCI) in patients with stable coronary artery disease, patients in the PCI group did not have improved survival or reduced risk of myocardial infarction. To assess the degree to which optimal medical therapy is implemented in patients with stable coronary artery disease who are referred for PCI, Borden and colleagues analyzed national cardiovascular disease registry data for patients who underwent PCI before and after the March 2007 publication of the COURAGE study results. The authors report that both before and after publication of COURAGE there was suboptimal use of optimal medical therapy prior to and at discharge following PCI.

Mr B, a 60-year-old man with hip and back pain, underwent spinal magnetic resonance imaging. He was found to have spinal stenosis and, incidentally, a renal mass suggestive of cancer. Mr B's primary care physician was reportedly not informed of the renal mass and Mr B was unaware of this finding until an orthopedic follow-up visit 4 months later. Schiff discusses delays and failures in diagnostic test follow-up and suggests strategies for improvement.

Assess your diagnosis and management skills with this new JAMA feature. Read the patient scenario, view the clinical image, and determine what you would do next.

“He wept softly. He was scared. He wanted more time.” From “Miles Together.”

Citing rising resistance to existing antibiotics and a dearth of new antibiotics under development as threats to public health, infectious disease experts are backing new proposals to tackle these problems.

Vaccine liability in the US Supreme Court

Public health implications of reduced government spending

NIH undiagnosed diseases program

Clinical information delivery

Join Lydia A. Bazzano, MD, PhD, Wednesday, May 18, from 2 to 3 PM eastern time to discuss antihypertensive treatment and cardiovascular disease (CVD) prevention for normotensive individuals with CVD. To register, go to http://www.ihi.org/AuthorintheRoom.

Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.

For your patients: Information about obsessive-compulsive disorder